Provider Demographics
NPI:1093030686
Name:BRUCE, TINA LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:LYNN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 CHAUNCEY ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1411
Mailing Address - Country:US
Mailing Address - Phone:347-533-6877
Mailing Address - Fax:
Practice Address - Street 1:668 CHAUNCEY ST
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1411
Practice Address - Country:US
Practice Address - Phone:347-533-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269244-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse